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AFFIDAVIT

To, Address of the Deceased Share Holder


The Director
Reliance Capital Ltd. 9,Sarai Meer Khan,
Address of Deceased
Village Meghpur/Padana, Allahabad
Lalpur, Dist. Jam Nagar,
Gujarat Date-02 may 2009

REG: (Full Name Deceased)


Arun Kumar Purwar

Dear Sir,

I regret to inform you that Mr.Arun Kumar Purwar who was registered share holder in your
company holding 2 Equity share bearing distinctive No(s) From 0225283772 to 0225283773 under
share certificate No(s) 016370606 died without leaving a will (intestate)/leaving his last will and
Testament dated 28-10-2008, Where of I am the only legal heirs/executors at Allahabad on 28-Oct-2008
leaving behind the within mentioned person (s) as the only surviving legal heirs according to the law of
Intestate by which he was governed at the time of his death.

I/We beg to give here below the information required by you and shall thank you to transfer the
said share bearing distinctive No(s) From From 0225283772 to 0225283773 under share certificate
No(s) 016370606 in favour of Suman Purwar and on my behalf, without insisting on production of legal
representation to the intestate of the deceased share holder:
1-Full Name of the Deceased holder Arun Kumar Purwar
And Address 9,Sarai Meer Khan, Allahabad
2-Share held singly/jointly Singly
3-No.of shares 2
bearing distinctive No(s) From 0225283772 to 0225283773
Share Certificate No(s) 016370606

4-Face value of the shares & 10


present Market value 524.00
5-In whose custody share certificate are? My ( Suman Purwar)
and reason for same
6-(a) had the diseased share holder left any will No
(b) Has the Estate duty & discharge certificate No
been obtained
(c) Has any probate /letter of Administration / No
Succession certificate to the Estate of the
Deceased has been obtained.
(d) Legal heirs /Executors/Administrators/ No
Successors to the Estate of the Deceased.

Name Occupation
i) Suman Purwar House Wife
7- Documents enclosed for registration and return
(a) Municipal Death certificate
(b) Estate duly dispatch certificate
8-Date and place of Death 28-10-2008 Allahabad
9-Full details of surviving legal heirs
Husband /Wife/children /parents/brothers/sisters ( If Hindu joint Family, the names and
address of the Karta and Do-parchers with their respective ages).
Full Name / Address Relationship with Deceased Age
i) Suman Purwar Wife 55
9,Sarai Meer Khan, Allahabad
10- Name(s) of the guardian of the minor children of the share holder Nil
11-The following persons have agreed to sign the indemnity bond as sureties jointly and
severally with all surviving legal heirs of the Deceased share holder.
Name & Name &
Signature Vinod Kumar Dubey Signature Pradeep Kumar Kesharwani
Address B-357, G.T.B. Nagar, Address 36/58, Sarai Meer Khan,
Allahabad Chowk, Allahabad
Occupation Business Occupation Business
Bank A/c No. 3168921 Bank A/c No. 61023099370
Banker’ Name United Bank Of India Banker’ State Bank of Bikaner & Jaipur,
and Address 53, Leader Road,Allahabad Name and Chowk, Allahabad
Address
I hereby solemnly affirm that the above statements are true that none of them or any part of them is false
and that nothing has been concealed therein and that I am the only executors and benefits under the said
share.

Yours faithfully

Telephone

Executed this day of 2009

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